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Acute Nephrology for the Critical Care Physician pp 167–173Cite as

Dose of Renal Replacement Therapy in AKI

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Abstract

Acute renal replacement therapy (RRT) requires a prescription outlining mode, target dose, type of anticoagulation, target fluid balance and measures of adequacy, however a formal dose prescription in acute RRT is often missing and effective delivery is not always measured. One potential reason for this omission is lack of consensus on the best way of measuring intensity of RRT and conflicting data related to the optimal dose. For continuous RRT (CRRT) dose is often expressed as the amount of dialysis/hemofiltration flow delivered to the patient in ml/kg per hour. Current international guidelines recommend delivering an effluent volume of 20–25 ml/kg/h for post dilution CRRT in AKI, taking into account the degree of ‘pre-dilution’ and ‘filter-down’ time. Based on the experience in patients with end stage renal disease (ESRD) it has been suggested that CRRT doses of <15 ml/kg/h are too low in critically ill patients, especially in the acute phases of illness. There is increasing evidence that fluid overload is detrimental to both renal outcome and survival in critically ill patients with AKI. It is not possible to recommend a general net ultrafiltration rate, instead the ultrafiltration rate should be tailored to the patients’ needs and haemodynamic and fluid status. The application of high-volume hemofiltration in severe sepsis and septic shock is not recommended based on the results of human studies. Also, there is increasing recognition that high dose CRRT increases drug clearance and may potentially lead to sub-therapeutic drug levels, including antibiotics, resulting in treatment failure.

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Author information

Authors and Affiliations

  1. Department of Intensive Care, Academic Medical Center, University of Amsterdam, 22660, 1100 DD, Amsterdam, The Netherlands

    Catherine S. C. Bouman MD, PhD

  2. Department of Critical Care, King’s College London, Guy’s and St Thomas’ Foundation Trust, London, SE1 7EH, UK

    Marlies Ostermann MD, PhD

  3. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, A-6020, Austria

    Michael Joannidis MD, PhD

  4. Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, 33000, France

    Olivier Joannes-Boyau MD

Authors
  1. Catherine S. C. Bouman MD, PhD
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  2. Marlies Ostermann MD, PhD
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  3. Michael Joannidis MD, PhD
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  4. Olivier Joannes-Boyau MD
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Corresponding author

Correspondence to Catherine S. C. Bouman MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Intensive Care, VU University Hospital, Amsterdam, The Netherlands

    Heleen M. Oudemans-van Straaten

  2. Department of Intensive Care Medicine, Anaesthesia Critical Care Collaborative, Research Group (SPACeR) and Faculty of Health Care Sciences, Royal Surrey County Hospital NHS, Foundation Trust, Surrey Perioperative, University of Surrey, Guildford, United Kingdom

    Lui G. Forni

  3. Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands

    A.B. Johan Groeneveld

  4. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Sean M. Bagshaw

  5. Division of Intensive Care and Emergency Medicine, Department of General Internal Medicine, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria

    Michael Joannidis

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Bouman, C.S.C., Ostermann, M., Joannidis, M., Joannes-Boyau, O. (2015). Dose of Renal Replacement Therapy in AKI. In: Oudemans-van Straaten, H., Forni, L., Groeneveld, A., Bagshaw, S., Joannidis, M. (eds) Acute Nephrology for the Critical Care Physician. Springer, Cham. https://doi.org/10.1007/978-3-319-17389-4_13

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  • DOI: https://doi.org/10.1007/978-3-319-17389-4_13

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17388-7

  • Online ISBN: 978-3-319-17389-4

  • eBook Packages: MedicineMedicine (R0)

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